Why Ayurgenomics researchers continue despite scepticism about research

If ancient and modern medicine share the same goal, maybe there could be a cross-talk between them

Young scientist Mitali Mukerji was having an ordinary day at Delhi’s Institute of Genomics and Integrative Biology (IGIB) when its director, Samir Brahmachari, walked up and handed her a piece of paper. Brahmachari had drawn a triangle in the middle of which was inscribed a Sanskrit word, prakriti. “Can you find out what this is?” Brahmachari asked Mukerji that afternoon in 2001. 

A bacterial geneticist, Mukerji had no idea what that triangle meant. She took that paper to her neighbour, who knew Sanskrit. He told Mukerji that Ayurveda classifies people based on their prakriti, or body type, made of three doshas or biological energies —Vata, Pitta and Kapha. Each dosha has distinct properties, and is present in varying degrees in every person. For example, Vata causes dry skin, and such people tend to be forgetful. Pitta people are prone to acne and have great digestion. Kapha people are more likely to gain weight and have poor digestion. Ayurveda practitioners customise treatment based on their patients’ prakriti, which also predicts what diseases people could get in future: Vata people are more likely to get brain diseases, Pitta skin diseases and Kapha heart diseases. 

“I found that very, very interesting,” Mukerji, now 51, tells me over samosa and chai at the IGIB canteen. Genomics research around that time was headed toward personalised medicine. If ancient and modern medicine share the same goal, maybe a cross-talk between them could lead to new ways to prevent and treat diseases, thought Mukerji and Brahmachari. They took this idea to the Traditional Knowledge Digital Library in Delhi, a government institute set up in 2001 to digitise India’s traditional medicinal knowledge texts, where they had several conversations with Bhavana Prasher, an Ayurveda expert. Together they started a project in 2002 to test whether genes contribute to a person’s prakriti. That project would later be named “Ayurgenomics”. 

After completing her PhD from Bengaluru’s Indian Institute of Science (IISc) in 1997, Mukerji joined biophysicist Brahmachari, who had just become the director of IGIB. The Human Genome Project, which was initiated in 1990 by the United States’ National Institutes of Health, was in full swing at the time. Scientists across the world were collaborating to map all human genes, which together makes a genome that works like a manual that guides a body’s build and maintenance. Brahmachari wanted to set up expertise in India to make use of the genome (its study is called genomics) after it is mapped. He and Mukerji began with setting up a framework to study diseases that run in Indian families over generations.

Brahmachari attended conferences to collect research ideas about “something that Western countries could not do”. At one conference about personalised medicine in 2000 he met Murli Manohar Joshi, science minister in the ruling Bharatiya Janata Party-led government at the time. Joshi told Brahmachari that Ayurveda too has a personalised medicine approach. The next year, while listening to Ayurveda experts at a meeting, Brahmachari drew that triangle on a paper.

It led Mukerji and Prasher to prepare a questionnaire that assessed people’s body frame, weight, skin, appetite, voice, memory, eye colour, and other such physical and physiological features to determine their prakriti. Researchers used that questionnaire to identify people of extreme prakriti — those who had one of the three doshas in high proportions. Mukerji took blood samples from them to analyse their DNA and run biochemical tests.

The results turned up significantly different across the three prakriti types. Kapha people, for example, had higher levels of serum uric acid — a predictor of cardiovascular diseases — in comparison to Pitta or Vata people. Researchers also found about 250 genes that expressed themselves differently across three prakriti types. A gene’s different expression could make one person more susceptible to a disease than another. When Mukerji sent the paper to PLOS One, a respected international journal, one editor rejected it, saying “anything you do with mythology defeats the purpose of science”. She recalls, “That’s how we started our journey.”

‘I had to prove my credibility so that people don't think I am doing hocus-pocus’ --- Mitali Mukerji (left), Ayurgenomics researcher Mitali Mukerji (left) seen here with Bhavana Prasher, an Ayurveda expert

Although the study was later published in another reputed journal, the Journal of Translational Medicine in 2008, the criticism continued. “A very poor study, completely unconvincing,” wrote Steven L Salzberg, professor at Baltimore’s Johns Hopkins University School of Medicine. Salzberg and other scientists who critique Ayurveda say that the prakriti concept has no scientific basis. Such things are “investigations into various paranormal phenomena,” wrote David Gorski, professor at the Wayne State University School of Medicine in Detroit. “It sounds like science; it acts like science; it tries to use the language of science; but it’s not science.”

Ayurvedic drugs have been criticised for containing heavy metals such as lead, mercury and arsenic. But some Ayurgenomics researchers aren’t convinced of the efficacy of Ayurveda drugs either: Brahmachari, for instance, is diabetic and takes modern medicines. “They [Ayurvedic drugs] need thorough scientific investigation,” he says. “I don’t believe in everything that Ayurveda says until it is scientifically tested.”

Brahmachari claims he coined the term Ayurgenomics after the 2008 study but B K Thelma, a geneticist at Delhi University, says she used the term first when she wrote a chapter, “From Genomics to Ayurgenomics”, in an academic book same year. Regardless of who said it first, what is notable is that some scientists are taking up Ayurgenomics.

Thelma turned to Ayurgenomics because of the growing frustration that, despite technological advancements including human genome mapping, there is little clarity about the genetic basis of complex diseases of heart, brain or immune system caused by the interactions between genes and their environment. These conditions make up about 60 per cent of all genetic diseases. “With that frustration, one is always looking at alternative paradigms,” says Thelma.

While Thelma has been using Ayurgenomics to study diseases, Mukerji and Prasher advanced their 2008 study by following up one gene, EGLN1, which expressed itself differently in extreme prakriti people. EGLN1 senses oxygen. A version of this gene linked to a life-threatening sickness at high altitudes (where oxygen is low) was found more frequently in Kapha people, whereas Pitta people had a version that helped them cope with less oxygen. The study was published in the respected Proceedings of the National Academy of Sciences in 2010. “This was the first time people started acknowledging that I am doing real science,” says Mukerji.

Her journey has not been easy. She is an alumna of IISc, which might explain why colleagues rolled their eyes when she began researching Ayurveda. “I was maybe a source of embarrassment to my colleagues,” said Mukerji. She turned to Brahmachari in difficult moments. “If you have many people agreeing with what you are saying,” Mukerji remembers Brahmachari telling her, “that means you are not doing something new.”

Over the years, Mukerji convened the Indian Genome Variation Consortium, which built “the first genetic landscape of the Indian population” by collecting DNA samples from populations in different parts of India to show how they are genetically related or different from each other. She helped develop a diagnostic test for spinocerebellar ataxia, a genetic nerve disease. In 2010, Mukerji became one of the few Indian women scientists to win the Shanti Swarup Bhatnagar Award, a top science honour. “I had to prove my credibility so that people don't think I am doing hocus-pocus,” she says.

When I reached out to some Indian geneticists to understand their views about Ayurgenomics, some didn’t respond, some said they didn’t know enough to comment, and some declined to comment. But despite the scepticism of the scientific community, Ayurgenomics has enjoyed political support. In 2012, the United Progressive Alliance government set up a Task Force to scientifically test Ayurvedic concepts, and gave Mukerji’s team Rs 48 crore to set up an Ayurgenomics unit and labs across India. In 2014, the BJP put Ayurgenomics in its manifesto, and sanctioned Rs 9 crore last year for Mukerji’s team.

Ayurgenomics researchers continue to publish papers. In 2017, Mukerji’s team published a study in PLOS One (the same journal that rejected her earlier paper), in which researchers used artificial intelligence to predict people’s prakriti. Another Ayurgenomics group led by Kumarasamy Thangaraj at the Centre for Cellular and Molecular Biology in Hyderabad published a study in 2015 in Nature identifying 52 genetic markers that distinguished the three extreme prakriti types from each other. Thelma’s 2012 paper in PLOS One showed Vata and Pitta people had gene variants that made them more susceptible to painful body joints in comparison to Kapha people.

Ayurgenomics researchers agree that Ayurveda presents an approach to overcome a modern medicine challenge of genetically diverse patients, which prevents doctors from giving targeted treatment. Ayurveda gets around that by clubbing diverse patients into somewhat similar groups based on their prakriti. Simply put, if you have 100 diabetes patients, you could club them into separate groups based on their prakriti, and then predict in which group diabetes is likely to cause eye damage because the prakriti of that group is linked to a particular gene variant. That is what Ayurgenomics researchers are trying to get at. Whether they will succeed remains to be seen. 

Mukerji doesn’t want people to write off Ayurveda or its practitioners “just because there is a stereotype about them.” She says. “I want to test it first.”